Bowel cancer treatment and side effects

jamtart

Prostate removal

Can you have partial removal of the prostate gland or is it all or nothing?

KatieR

The definition of a prostatectomy is ‘ removal of all or part of the prostate gland ‘ Ive only googled it There will be lots of people on here who will know better than I
Cath -

Bear G

Hi @jamtart
There may be some on here who have experience of this but I’m tagging @Charlotte Nurse Advisor for her expert input. It may take a couple of days for her to reply as I know she’s been out of the office at a conference.
In the meantime you could try calling the nurse helpline for a chat.

Big hugs
Bear
:x::x:

Charlotte Nurse Advisor

Dear @jamtart,

The term prostatectomy can describe the removal of part or all of the prostate gland. Ordinarily (in the treatment of prostate cancer) the whole organ is removed. Can I ask in what context you are enquiring? Is this relating to the treatment of bowel cancer?

Kind regards

Charlotte

jamtart

@Charlotte Nurse Advisor OH has a tumour at the front of his rectum, he has had chemo/radiotherapy and from the latest scan it is unclear what is left at the site. The only way it can be confirmed whether It is cancerous or scar tissue is under a microscope which means removing his rectum. It is unclear from the scan whether the prostate is affected too and surgeon is saying to remove both prostate and bladder. The lesser option is to remove the rectum, but if the area is cancerous not scar tissue, this risks seeding.
I wanted know if part of the prostate can be removed to give a clear margin rather than removing the prostate and bladder

Charlotte Nurse Advisor

Dear @jamtart,

Many thanks for the further information.

When a bowel tumour invades other organs such as the prostate in men (or uterus in women) sometimes it is necessary to remove the two organs 'en bloc' to ensure no seeds are left behind. In your OH situation it seems they think there is possible involvement of both the prostate and the bladder - is this the case?

Whilst scans can give a good idea of what is going on sometimes the definitive decision has to made at the time of surgery. Occasionally whilst a scan may indicate that two organs are stuck together by the tumour or scar tissue when it comes to the operation it is easier to separate the organs than previously thought - the same of course can be true in reverse.

Have you further appointments to discuss the way forward with his surgeon?

Kind regards,

Charlotte

jamtart

@Charlotte Nurse Advisor we had another meeting with the surgeon yesterday and he showed us the latest MRI scan. They do not know if the prostate is involved only that it is laying against the rectum at the tumour site, we couldn't see any tumour. At original meeting we were told the bladder would be removed because the urethera runs through the prostate and if there has been spread to the prostate it could also have spread into the bladder, but would only know this from pathology result.
OH's latest CT scan shows no evidence of disease, the results of which were given to us in isolation of any other information and we celebrated too early, but that's another story.
Also to take into account is the fact that OH had a double heart by-pass 10 years ago so there is an added risk to any surgery.
Surgeon could see we still had many questions and doubts and has suggested taking more time to consider surgery and in the meantime to meet oncologist again and have another round of chemo.
We have no other results in our possession, we are going to contact colorectal nurse and ask about CEA markers.

Charlotte Nurse Advisor

Dear @jamtart,

It is difficult to comment further. From what you are saying it is possible that he has had a complete response to the radiotherapy and there is no residual tumour - just scar tissue. This, as the surgeon has correctly said, can only be confirmed by proceeding with the operation and examining the specimen under a microscope.

Whilst a complete response to chemoradiotherapy is in fact a good thing, and we are increasingly seeing this as our radiotherapy gets better, it does leave this very difficult decision of what to do next as without the specimen it is difficult to be certain.

For some patients it is possible to offer a watch and wait approach and if further activity is noticed on scans then the patient proceeds to have the operation that would have originally been done. It does appear in your OH's case though that there is still some significant doubt as to whether he has had a complete response and so surgery is still being recommended??

Regards,

Charlotte

jamtart

@Charlotte Nurse Advisor At the Latest appointment with consultant we managed to glean staging has gone from initial t4 n1 v0 to t3 n0v0 ct scan showing no metastic spread, and cea markers have always been in normal range, another MRI scan and follow up appointment and 2nd opinion asked for and agreed on.
In limbo and going around in circles, still not understanding why a perfectly healthy bladder would be removed. 🤔😕

Charlotte Nurse Advisor

Dear @jamtart ,

It is good to hear that a 2nd opinion has been agreed upon as this will be an opportunity to ask further questions about the surgery.

I can't really comment on the bladder issue but suffice to say I cannot think of any surgeon who would remove an organ that he or she didn't have to. This may be due to invasive cancer or such severe scar tissue remaining after radiotherapy treatment that it is impossible to separate the two organs (in this case the rectum and the bladder) from one another.

I would definitely ask for further clarification on this at his 2nd opinion appointment.

With kindest regards,

Charlotte